Storage

Guidelines for storing human milk vary slightly depending on the resource you use. This article cites the recommendations from La Leche League International (as posted in the web FAQ) and the Centers for Disease Control website on breastfeeding. Mothers should be encouraged to test their milk whenever they doubt its freshness by smell and taste. It’s impossible to discern freshness visually. Human milk has a wide range of normal colors. The separation of fat can vary greatly as well. When in doubt, throw it out.

On the counter: 4 hours according to LLLI, 6-8 hours according to CDC In a cooler on “blue ice” packs with packs in contact with milk containers: 24 hours according to CDC

In the refrigerator: 3-8 days according to LLLI, 5 days according to CDC
In the freezer (do not store milk in the freezer door. It will be exposed to more drastic temperature changes in the door compartment.): 6-12 months according to LLLI, 3-6 months according to CDC
In a sub zero “deep” freezer: 6-12 months according to CDC

For minimum waste, store milk in 2 ounce portions. Some mothers find storing in 1, 2, and 3 ounce portion gives them more flexibility and less waste.

Heating

Thaw frozen milk in the refrigerator or in a bowl of warm water. Do not microwave. Do not submerge in boiling water. Milk storage baggies are not designed to withstand high heat.

Milk that is thawed can be heated in the bottle in a bottle warmer or pan of warm water. Remember, the milk need only be heated to body temperature, not made hot.

Milk will naturally separate after expression. Swirl heated milk bottle gently to mix fat layer back into solution. Do not shake. Shaking puts bubbles in the milk making the flow out of the bottle less smooth. Bubbles may increase gas. Human milk contains fat chains of long and short lengths. Shaking may disrupt the fats.

Choosing a bottle and artificial nipple

A slow flow artificial nipple is ideal for the duration of breastfeeding. Babies who alternate between breast and bottle will continue with a slow flow nipple until they transition to a cup. Slow flow nipples will keep your baby bottle feeding on a pace more similar to the breast to make the transition back and forth easier.

No brand of artificial nipple creates a latch like breastfeeding despite marketing claims. In fact, advertising a teat this way is a violation of the World Health Organization’s international code of marketing breast-milk substitutes. There is no shape, material, or insert that is like a human breast. When choosing an artificial nipple, the one that is slow flow, able to be sanitized, non-allergenic, and agreeable to the baby is the right choice. What works for one family may not work for another.

Breastfed babies rarely have stomachs larger than 3-5 ounces, even at 6-9 months. When choosing a bottle, small bottles are sufficient. Large bottles of 6 ounce capacity or more are for formula feeding.

Many parents are concerned about chemicals in plastics. Many bottle companies now offer BPA free plastics. Glass bottles are also growing in popularity. Glass bottles now are on the market that have rubber sleeves to help prevent shattering. The type of bottle a family chooses is a personal decision.

Paced Bottle Feeding

1. Hold baby mostly upright. Babies cannot regulate the flow of a bottle when lying on their backs or reclined.
2. Hold bottle parallel to the floor. It’s okay if some air is in the tip of the nipple.
3. Place the tip of the nipple on the baby’s upper lip. Baby will open the mouth wide. Gently insert bottle nipple into the mouth completely. The baby’s lips should be flanged at the base of the nipple.
4. Let the baby drink 1 ounce. Gently tip the bottle down to give a rest break without breaking the latch. Babies are able to stop the flow of the breast easily. Gravity prevents babies from controlling the flow of a bottle the same way. These short breaks help the baby bottle feed more similarly to breastfeeding and give them a chance to cue fullness.
5. Feed a second ounce and provide a second break by removing the bottle nipple from the baby’s mouth.
6. If baby shows hunger cues, switch the baby to the other side of the body. Breastfed babies coordinate left-right because they are switched from side to side. The second half of the feed should be done with the care giver holding the baby on the opposite side.
7. Latch the baby to the bottle nipple and feed again just like instructions 1-4. Continue to feed ounce by ounce with breaks in between to allow baby to burp and cue fullness.
8. The baby should spend as much time at the bottle feed as he would at a breast feed.
9. Never encourage a baby to finish a bottle. Always follow cues of hunger and fullness. Scheduled feeds are not recommended by any health organization.

Why is pacing the feed so important?

Many mothers misjudge their milk supply due to incorrect bottle feeding. A baby held in a reclined position during a bottle feed will have milk flood the mouth due to gravity. Babies are smart. They will swallow the milk in order to protect their airway. They don’t want to aspirate the milk into their lungs. This is why many mothers report that their baby “sucked down” a bottle rapidly.

Babies bottle fed this way generally have an easier time feeding at both the breast and bottle. So called “nipple confusion” is decreased. Many babies will learn the flow differences of reclined bottle feeding and breastfeeding. These feeding methods use different facial muscles. Feeding at the breast is shown to provide optimal craniofacial development. Paced bottle feeding can help a baby enjoy the benefits of breastfeeding when mother and baby are together.